Current through Register No. 40, October 3, 2024
(a) An enrolled
provider that offers services under these rules shall be:
(1) An LEA or SAU; and
(2) Enrolled as a New Hampshire medical
assistance provider.
(b)
Covered services shall be:
(1) Provided
through a student's LEA or SAU; and
(2) Designed to meet the health needs of a
student by facilitating the reduction of a physical or mental impairment and
providing rehabilitation.
(c) Covered services shall be included in the
student's IEP.
(d) Covered services
shall be provided by programs approved by the department of education in
accordance with RSA
186-C:2, II.
(e) Covered services shall be provided in a
variety of locations and settings as specified in a student's IEP and may occur
outside the hours of the usual school day.
(f) Covered services may be provided by staff
employed or subcontracted by the enrolled provider.
(g) Covered supplies and equipment described
under He-M
1301.04 shall:
(1)
Be acquired for the use of a specific student;
(2) When purchased, be the property of the
student and his or her family; and
(3) When rented or acquired through a used
equipment exchange program, be the property of the student and his or her
family during the period used.
(h) Medical evaluation shall be a covered
service and shall include the following:
(1)
Those services rendered by a physician or other licensed practitioner of the
healing arts whose opinion or advice is requested regarding the evaluation or
treatment of a student's condition;
(2) The course of treatment or therapy
suggested by the physician or other licensed practitioner of the healing arts
which is overseen by the referring physician or other licensed practitioner of
the healing arts; and
(3) If the
physician or other licensed practitioner of the healing arts assumes the
continuing care of the student, any service(s) provided by such physician or
practitioner subsequent to the initial evaluation shall not be considered an
evaluation.
(i) The
following medical services shall be billable under the category of medical
evaluation:
(1) Examination of a single organ
system, including:
a. Documentation of
complaint(s);
b. Physical
examination and diagnosis of current illness; and
c. Establishment of a plan of management
relating to a specific problem; and
(2) In-depth evaluation with development and
documentation of medical data, including:
a.
Chief complaint;
b. Present
illness;
c. Family
history;
d. Medical
history;
e. Personal
history;
f. System review;
and
g. Physical
examination.
(j) Nursing services necessary to meet the
health needs of a student as described under
He-M
1301.03(a) shall be covered services
and shall include:
(1) Any evaluations,
treatments or consultations performed by a licensed registered nurse, licensed
practical nurse, advanced practice registered nurse (APRN) for a student that
are necessary in order for the student to benefit from an educational program;
and
(2) Supplies and equipment
necessary for the provision of the covered nursing services as determined by
the licensed registered nurse, licensed practical nurse or advanced practice
registered nurse.
(k) A
nurse shall be an advanced practice registered nurse, a registered nurse, or a
licensed practical nurse licensed to practice in New Hampshire or the state in
which he or she practices.
(l)
Covered nursing services shall include the following:
(1) Administration of
medication(s);
(2) Positioning or
repositioning;
(3) Assistance with
specialized feeding programs;
(4)
Management and care of specialized medical equipment such as:
a. Colostomy bags:
b. Nasogastric tubes;
c. Tracheostomy tubes; and
d. Related devices;
(5) Observation of students with chronic
medical illnesses in order to assure that medical needs are being appropriately
identified, addressed, and monitored; and
(6) Other services determined by a registered
nurse, licensed practical nurse, or advanced practice registered nurse to be
necessary and appropriate.
(m) Billable categories of nursing services
shall include the following:
(1) Nursing
evaluation;
(2) Nursing
treatment;
(3) Nursing
consultation;
(4) Development and
documentation of student-specific health information related to the
practitioner's scope of practice; and
(5) Supplies and equipment necessary to
provide covered nursing services.
(n) Occupational therapy services shall be a
covered service if the services are necessary to implement a program of
activities in order to develop or maintain adaptive skills necessary to achieve
adequate and appropriate physical and mental functioning of a student
including:
(1) Any evaluations, treatment, or
consultations performed by a professional qualified under (o) below of students
whose abilities to carry out age appropriate tasks are threatened or impaired
by physical illness or injury, emotional disorder, or congenital or
developmental disability; and
(2)
Supplies and equipment necessary to provide the covered occupational therapy
services as recommended by an occupational therapist qualified under (o)
below.
(o) Occupational
therapy services shall be provided by:
(1) An
occupational therapist who is licensed to practice in New Hampshire or the
state in which he or she practices, and is either:
a. Registered by the National Board for
Certification in Occupational Therapy Inc.; or
b. A graduate of a program in occupational
therapy approved by the Committee on Allied Health Education and Accreditation
of the American Medical Association and engaged in the supplemental clinical
experience required before registration by the National Board for Certification
in Occupational Therapy, Inc.; or
(2) An occupational therapy assistant as
defined in RSA
326-C:1, IV working under the direction of a
qualified professional identified pursuant to (1) above.
(p) Covered occupational therapy services
shall be referred by a physician or other licensed practitioner of the healing
arts practicing under his or her scope of practice specified in state law and
rules.
(q) Persons providing
occupational therapy services shall use treatment techniques including:
(1) Task-oriented activities to correct
physical or emotional deficits or to minimize the disabling effect of these
deficits in the life of the individual;
(2) Evaluations of:
a. Sensorimotor abilities;
b. Self-care activities;
c. Capacity for independence;
d. Physical capacity for prevocational and
work tasks; and
e. Play and leisure
performance;
(3)
Specific occupational therapy techniques involving:
a. Improving skills for activities of daily
living;
b. The fabrication and
application of splinting devices;
c. Sensorimotor activities;
d. The use of specifically designed manual
and creative activities;
e.
Guidance in the selection and use of adaptive equipment; and
f. Specific exercises to enhance functional
performance and physical capabilities needed for work activities; and
(4) Other services determined by
an occupational therapist to be necessary and appropriate.
(r) Billable categories of occupational
therapy services shall include the following:
(1) Occupational therapy
evaluation;
(2) Occupational
therapy, individual;
(3)
Occupational therapy, group; and
(4) Occupational therapy,
consultation;
(5) Development and
documentation of student-specific health information related to the provider's
scope of practice; and
(6) Supplies
and equipment necessary for the provision of covered occupational therapy
services.
(s) Physical
therapy services shall be covered services including:
(1) Any evaluations to determine a student's
level of physical functioning, including performance tests to measure
strengths, balance, endurance, and range of motion;
(2) Any treatment services or consultations
which might utilize therapeutic exercises or the modalities of heat, cold,
water, and electricity, for the purpose of preventing, restoring, or
alleviating a lost or impaired physical function; and
(3) Other services, including supplies and
equipment, determined by a physical therapist to be necessary and appropriate
for a student's physical therapy.
(t) Physical therapy services shall be
provided by:
(1) A physical therapist who is
a graduate of a program of physical therapy approved by the Committee on Allied
Health Education and Accreditation of the American Medical Association and the
American Physical Therapy Association or its equivalent and licensed to
practice in the state of New Hampshire or the state in which he or she
practices; or
(2) A physical
therapy assistant as defined in
RSA
328-A:2, VIII who is under the direction of a
qualified professional identified pursuant to (1) above.
(u) Covered physical therapy services shall
be ordered from a physician or other licensed practitioner of the healing arts
practicing within his or her scope of practice as specified in state law and
rules for covered physical therapy services.
(v) Billable categories of physical therapy
services shall include the following:
(1)
Physical therapy, evaluation;
(2)
Physical therapy, individual;
(3)
Physical therapy, group;
(4)
Physical therapy consultation;
(5)
Development and documentation of student-specific health information related to
the provider's scope of practice;
(6) Supplies and equipment necessary for the
provision of covered physical therapy services;
(7) Development and documentation of
student-specific health information related to the provider's scope of
practice; and
(8) Supplies and
equipment necessary for the provision of covered occupational therapy
services.
(w)
Psychiatric services shall be covered services if recommended by a licensed
physician to be necessary for the evaluation, diagnosis, and treatment of
psychiatric problems in order for a student to benefit from an educational
program.
(x) Psychiatric services
shall be provided by a psychiatrist who is a physician licensed to practice in
New Hampshire or the state in which he or she practices and either board
certified or board eligible according to the most recent regulations of the
American Board of Psychiatry and Neurology, Inc. or its successor
organization.
(y) Billable
categories of psychiatric services shall include the following:
(1) Psychiatric evaluation and
diagnosis;
(2) Psychiatric
treatment;
(3) Psychiatric
consultation; and
(4) Development
and documentation of student-specific health information related to the
provider's scope of practice.
(z) Psychological services shall be covered
services and if recommended by a certified psychologist to be necessary for the
evaluation, diagnosis, and treatment of emotional or behavioral problems or
disturbances in order for a student to benefit from an educational program.
(aa) Psychological services shall
be provided by a psychologist who is a school psychologist or associate school
psychologist certified by the state board of education in New Hampshire or in
the state in which he or she practices, or a psychologist or associate
psychologist certified by the New Hampshire board of psychologists or certified
or licensed in the state in which he or she practices.
(ab) Billable categories of psychological
services shall include the following:
(1)
Psychological testing and evaluation;
(2) Psychodiagnostic testing;
(3) Psychological, individual
treatment;
(4) Psychological, group
treatment;
(5) Family counseling,
during which the student shall be present at some point during the
counseling;
(6) Psychological
consultation; and
(7) Development
and documentation of student-specific health information related to the
provider's scope of practice.
(ac) Mental health services shall be covered
services if they are services other than psychiatric and psychological services
identified pursuant to (w) -(ab) above that enable the student to benefit from
an educational program in the least restrictive setting including, at a
minimum:
(1) Behavior management;
(2) Individual, group, and family
counseling;
(3) Crisis
intervention; and
(4) Development
and documentation of student-specific health information related to the
provider's scope of practice.
(ad) Persons providing mental health services
shall be certified pursuant to
Ed
507.06, school counseling director,
Ed
507.07, school counselor,
Ed
507.14, school social worker, by a community mental
health program in accordance with He-M 426, or licensed to practice mental
health pursuant to New Hampshire
RSA
330-A:18,
RSA
330-A:19, or licensed in the state in which
he or she practices.
(ae)
Rehabilitative assistance shall be a covered service and include assistance
with:
(1) Mobility;
(2) Communication;
(3) Behavioral management;
(4) Nutrition;
(5) Medications;
(6) Personal care;
(7) Supported employment for students with
vocational IEP goals excluding teaching of job tasks, performing job tasks, or
providing academic instruction and including, at a minimum:
a. Enhancing social and personal development;
and
b. Consultation services in
communication, mobility, physical, psychological, or medical well-being in the
context of vocational goals and employment settings; and
(8) Any other remedial services, excluding
classroom instruction and academic tutoring, that are included in the student's
IEP as necessary for the maximum reduction of a student's physical or mental
disabilities.
(af)
Persons who provide rehabilitative assistance shall:
(1) Be certified pursuant to
Ed
504.05 or
Ed
504.06, requirements and certification for
paraeducators;
(2) Have
qualifications equivalent to the requirements for certification under
Ed
504.05 or 504.06; or
(3) Be licensed practitioners of the healing
arts practicing within the scope of his or her practice defined under the law.
(ag) Persons providing
rehabilitation assistance under
Ed
504.05 or
Ed
504.06 as paraeducators, or with qualifications
equivalent to Ed 504.05 or 504.06, shall
provide services in accordance with
Ed
1113.12(b) and (c) .
(ah) There shall be a physician's referral or
a recommendation from a licensed practitioner of the healing arts practicing
within his or her scope of practice as defined under state law for
rehabilitative assistance services.
(ai) Provision of rehabilitative assistance
services shall be reviewed by a licensed practitioner of the healing arts at
least weekly. Such review shall include consultation with the staff person
providing the rehabilitative assistance. The licensed practitioner of the
healing arts conducting the review shall, as part of the review, sign the
documentation of the service provided in order to verify that the service was
provided.
(aj) Billable categories
of student rehabilitative assistance shall include the following:
(1) Student rehabilitative assistance,
individual;
(2) Student
rehabilitative assistance, group; and
(3) Development and documentation of
student-specific health information related to the provider's scope of
practice.
(ak)
Pre-school services shall be covered services and include speech and language
services, mobility and orientation, family counseling and information services,
and nutrition services. There shall be a physician's referral or recommendation
for covered pre-school services from a licensed practitioner of the healing
arts practicing under his or her scope of practice defined in state
law.
(al) Pre-school services shall
be provided by programs approved by the department of education in accordance
with RSA
186-C:2, II.
(am) Pre-school service shall be billed as a
single category based on a half-day unit. A half-day unit shall equal at least
2 hours and not more than 4 hours of service or, at the option of the LEA, be
billed as discrete services based on the units of covered service actually
provided.
(an) Speech, language,
and hearing services shall be covered services if they are services, supplies,
and equipment recommended by a licensed audiologist or licensed speech
pathologist to be necessary for the evaluation, diagnosis and treatment of
speech, language, and hearing disorders which result in communication
disabilities.
(ao) Speech,
language, and hearing services shall be provided by:
(1) An audiologist who is licensed to
practice in New Hampshire or the state in which he or she practices;
(2) A speech pathologist who is either:
a. Licensed pursuant to RSA 326-F to practice
in New Hampshire, which shall be considered equivalent to having met the
requirements for the American Speech-Language-Hearing Association (ASHA)
Certificate of Clinical Competence in Speech-Language Pathology; or
b. Licensed in the state in which he or she
practices and have one of the following:
(i)
A Certificate of Clinical Competence from the American Speech and Hearing
Association; or
(ii) Completed the
equivalent educational requirements and work experience necessary for the
certificate; or
(iii) Completed the
academic program and is acquiring supervised work experience to qualify for the
certificate;
(3) A speech-language assistant as defined in
RSA
326-F:1, II-a working under the direction of
a qualified professional identified pursuant to (2) above;
(4) A speech-language assistant as allowed in
RSA
326-F:2, I(c), working under the direction of
a qualified professional identified pursuant to (1) or (2) above; or
(5) A speech-language specialist who meets
the requirements of Ed 507.23 and works under the
direction of the qualified professional in (1) or (2) above.
(ap) There shall be a referral
from a physician or a licensed practitioner of the healing arts practicing
within his or her scope of practice as defined in state law for covered speech,
language, and hearing services.
(aq) Billable categories of speech, language,
and hearing services shall include the following:
(1) Individual speech, language, or hearing
evaluation;
(2) Speech, language,
or hearing therapy, individual treatment;
(3) Speech, language, or hearing therapy,
group treatment;
(4) Speech,
language, or hearing consultation;
(5) Development and documentation of
student-specific health information related to the provider's scope of
practice; and
(6) Supplies and
equipment necessary for the provision of covered speech language and hearing
services.
(ar) Vision
services shall be covered services if they are services recommended by a
licensed optometrist, ophthalmologist, or other practitioner of the healing
arts to be necessary for the prevention or rehabilitation of visual impairment
or restoration of a student with a visual impairment to his or her best
possible functional level.
(as)
Vision services other than those prescribed or provided by an optometrist and
ophthalmologist shall be provided in accordance with a recommendation for
covered vision services by a physician or other licensed practitioner of the
healing arts, practicing under his or her scope of practice defined in state
law.
(at) Billable categories of
vision services shall include:
(1) Aids to
vision prescribed by an ophthalmologist or an optometrist;
(2) Mobility and orientation
training;
(3) Braille instruction
and materials;
(4) Services and
supplies related to diagnostic screening and prevention of visual disorders;
and
(5) Other services and supplies
necessary for the provision of restoration of vision or related functioning to
the best possible functional level.
(au) Specialized transportation shall be a
billable service as follows:
(1)
Transportation shall be listed in the student's IEP as a required
service;
(2) Transportation shall
be considered a required service if:
a. The
child requires transportation in a vehicle specially adapted to serve the needs
of the disabled child, including a specially adapted school bus; or
b. The child resides in an area that does not
have school bus transportation, such as those areas in close proximity to a
school, but has a medical need for transportation that is noted in the
IEP;
(3) The following
transportation may be billed as a medicaid service:
a. Transportation to and from school only on
a day when the student receives a medicaid coverable service at school during
the school day; and
b.
Transportation to and from a medicaid coverable service in the community during
the school day;
(4) The
medicaid coverable service in (3) a. and (3) b. above shall be listed in the
student's IEP as a required service; and
(5) In addition to the documentation required
by He-M
1301.06, transportation providers shall maintain a
daily transportation log to include:
a.
Student's name;
b. Date of
service;
c. Clear indication that
the student is being transported either one-way or round-trip;
d. The total number of students on the bus,
both in the morning and the afternoon;
e. The total miles the bus traveled, both in
the morning and the afternoon;
f.
Driver's name; and
g. Driver's
signature.
#4925, INTERIM, eff 8-31-90; ss by #5038, eff 12-28-90;
ss by #5456, eff 9-1-92, EXPIRED: 9-1-98
New. #6861, INTERIM, eff
10-2-98, EXPIRED: 1-30-99
New. #6987, eff 4-27-99; ss by
#8874, INTERIM, eff 4-25-07, EXPIRED 10-22-07
New. #9035, eff 11-22-07; amd
by #10278, eff 2-23-13
The
amended version of this section by
New
Hampshire Register Volume 38, Number 37, eff.
8/20/2018 is not yet
available.
The
amended version of this section by
New
Hampshire Register Volume 39, Number 37, eff.8/28/2019 is not yet
available.
